Smoking cessation and inattention or hyperactivity/impulsivity: A post hoc analysis

Abstract

Tobacco use is more prevalent and smoking cessation less likely among persons with attention deficit hyperactivity disorder (ADHD) than the general population. Evidence that tobacco use and nicotine hold divergent relationships with inattention (IN) and hyperactivity/impulsivity (HI), the core symptoms of ADHD, prompted this post hoc investigation of abstinence patterns by type of ADHD symptoms. Subjects were 583 adult smokers treated openly with bupropion and nicotine patch during the initial eight-week phase of a maintenance treatment study. Using the ADHD Current Symptom Scale, clinically significant ADHD symptom subtypes, i.e., predominantly inattention (ADHD-IN) and predominantly hyperactivity/impulsivity with or without inattention (ADHD-HI+/-IN), were identified. The study outcome was abstinence status, verified by expired carbon monoxide <8 parts per million, at five clinic visits from Week 1 through the end of treatment at Week 8. The distribution by ADHD symptom status was: No ADHD=540; ADHD-IN=20; ADHD-HI+/-IN=23. The study groups did not differ on demographic or smoking variables. The frequency of past major depression was highest with ADHD-IN and the frequency of past alcohol dependence was highest with ADHD-HI+/-IN. Compared to smokers with no ADHD, smokers of both ADHD subtypes combined showed lower abstinence rates throughout the study (OR=0.54, 95% CI: 0.32-0.99). Disaggregation by symptom subtype and separate comparisons against smokers with no ADHD showed that lower odds of quitting occurred mainly with ADHD-HI+/-IN (OR=0.40, 95% CI:=0.19-0.82), not with ADHD-IN (OR=0.74, 95% CI=p=0.36-1.51). Combined bupropion and nicotine patch treatment appears to be helpful for smokers with IN but not smokers with HI symptoms. The reasons for this divergent treatment response warrant further investigation.

Attention-Deficit/Hyperactivity Disorder and Nicotine Dependence in Adults

“…In studies that examined the relationship among ADHD symptoms and smoking outcome, prediction of various tobacco use measures, such as initiation, progression to regular smoking or ND, and increased tendency to relapse, more apparent connection was evident in favor of hyperactivity/ impulsivity, rather than inattention (16,37,38,39,40). However, in our study there was no significant relationship between ADHD impulsivity/hyperactivity scores and Fagerstrom scores.…”

“…Since the relation of ADHD symptoms and smoking might show alterations over time; more severe inattention symptoms may be related to acceleration of ND symptoms in adolescence and deceleration during adulthood (39). Moreover, comorbidity of alcohol dependence was an exclusion criterion in our study, and it is suggested that comorbidity of alcohol dependence might play role in the relationship between ADHD hyperactivity/impulsivity and ND due to the effect of alcohol on impulsivity (2,16). Another dissimilarity of the current study from the previous studies was the criteria based on a history of lifetime regular cigarette use which was defined as smoking ≤10 cigarettes per day was distinct from the other studies in which the primary smoking outcome variables were generally defined on the basis of much more infrequent use (e.g., ever tried at least one puff of a cigarette) (41).…”

“…Attention-Deficit/Hyperactivity Disorder subtypes such as (i) predominantly inattention, (ii) predominantly hyperactivity/impulsivity, and (iii) combined inattention and hyperactivity/impulsivity demonstrate distinct characteristics of psychiatric comorbidities (16). Evidence are present regarding nicotine improves attentiveness and decreases deficits in dopaminergic function related to inattention problems, executive dysfunction especially inattention, and therefore implying these as some of the factors to promote smoking in adolescents and young adults, prevailing both for ADHD diagnosed or individuals without a diagnosis of ADHD (17,18,19,20).…”

“…Therefore, the hypothesis that smoking represents a form of self-medication against the ADHD symptomatology among adult smokers has significant validity (24). On the other hand, the impact of hyperactivity/ impulsivity as a distinct phenomenon was shown to be more pronounced than the concept of inattention over smoking outcome and prediction of various tobacco use measures, such as initiation, progression to regular smoking, nicotine dependence and increased tendency to relapse (16).…”

Nicotine Alters Limbic Function in Adolescent Rat by a 5-HT1A Receptor Mechanism

“…Smoking and neuropsychiatric disease often co-occur, with the onset of both disorders emerging during adolescence (Covey et al, 2008;Gehricke et al, 2007;Weiser et al, 2004). The adolescent brain undergoes dynamic maturation of limbic circuitry and of efferent dopamine (DA) and serotonin (5-HT) neurotransmitter systems, which are common components that underlie the rewarding aspects of smoking, as well as neuropsychiatric pathologies.…”